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Pertzye Assistance Program
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1120 Win Drive
Bethlehem, PA 18017
Phone
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610-882-5950
Fax:
610-882-0349
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Eligibility
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Insurance is determined case by case. Medicare Part D patients are not eligible for this program. Income requirements are determined case by case. US residency not specified. |
| Who Can Apply
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Doctor/Doctor's office must call and have application faxed to the office. Application is returned via fax. Doctor will be notified of decision. |
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Required
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Doctors and patients must complete and sign the application. |
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Supply
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Up to 3 month supply. New application process required for refills. Refill limit not specified. |
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Ship To
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Medication shipped to Doctor's office within 5-7 business days. |
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Note
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**Physicians apply for this program on behalf of their patients.
Each applicant is looked at on a case by case basis.
If another supply is needed, the physician is to submit another enrollment form.
This program also provides copay assistance and has a Nutritional Rebate Program. |
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Includes Support for This Drug
NOTE: Linked drugs are available for Prescribers to Apply Online now.
Click drug logo or drug name to start online application.
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| Pertzye capsule; delayed release |
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